采用不同尿流改道方法对行腹腔镜膀胱癌根治术后男性患者生活质量和性功能的影响分析

Analysis of the Influence of Different Urinary Diversion Methods on the Quality of Life and Sexual Function of Male Patients Undergoing Laparoscopic Radical Bladder Cancer Surgery

目的探讨对腹腔镜膀胱癌根治术患者采用不同尿流改道方法进行干预后对其术后性功能以及生活质量产生的影响。方法将该院2017年6月—2020年2月收治的104例腹腔镜膀胱癌根治术患者数字奇偶法分组;干预组(52例)采用原位回肠新膀胱术展开手术干预;对照组(52例)采用回肠膀胱术展开手术干预;就组间术中失血量、健康状况调查简表(SF-36)评分、术后并发症情况以及性功能指标评分展开对比。结果干预组腹腔镜膀胱癌根治术患者术中失血量(544.16±85.35)mL同对照组(533.76±73.12)mL比较,差异无统计学意义(t=0.667,P>0.05);干预组腹腔镜膀胱癌根治术患者生理功能(78.25±2.53)分、生理职能(78.59±3.03)分、活力(78.11±6.25)分、情感职能(77.59±5.29)分、社会功能(78.13±6.03)分以及心理健康(79.02±7.01)分均高于对照组(58.29±3.03)分、(57.12±3.05)分、(57.89±4.05)分、(60.12±5.05)分、(62.29±6.03)分以及(62.29±6.03)分,差异有统计学意义(t=36.463、36.011、19.578、17.225、13.394、13.047,P<0.05);干预组腹腔镜膀胱癌根治术患者切口感染、尿道感染、肾积水、肾功能损伤以及肠梗阻发生率同对照组比较,差异无统计学意义(P>0.05);干预前,干预组腹腔镜膀胱癌根治术患者亚利桑那性体验表(ASEX)评分(29.85±1.55)分以及国际勃起功能指数(IIEF-5)评分(11.46±5.12)分同对照组(29.92±1.53)分、(11.66±4.85)分比较,差异无统计学意义(t=0.231、0.204,P>0.05);干预后,干预组ASEX评分(14.63±2.73)分低于对照组(22.46±4.36)分,差异有统计学意义(t=10.976,P<0.05),IIEF-5评分(17.49±3.32)分高于对照组(13.62±2.55)分,差异有统计学意义(t=6.666,P<0.05)。结论原位回肠新膀胱术的应用表现出较高操作难度,但能够对腹腔镜膀胱癌根治术患者正常排尿功能进行保留,针对其术后性功能以及生活质量不会产生严重影响,最终实现腹腔镜膀胱癌根治术患者有效预后。

Objective To investigate the effects of different urinary diversion methods on patients undergoing laparoscopic radical bladder cancer surgery and their postoperative sexual function and quality of life.Methods 104 cases of patients undergoing laparoscopic radical bladder cancer surgery in the hospital from June 2017 to February 2020 were divided into groups by digital parity;the intervention group(52 cases)used orthotopic ileal neobladder surgery for surgical intervention;the control group(52 cases)used ileal bladder surgery for surgical intervention;the intraoperative blood loss and health status survey summary(SF-36)scores between the groups,Postoperative complications and sexual function index scores to expand comparison.Results There was no significant difference in blood loss(544.16±85.35)mL of patients undergoing laparoscopic radical bladder cancer surgery in the intervention group and the control group(533.76±73.12)mL(t=0.667,P>0.05);in the intervention group,laparoscopic bladder cancer Radical surgery patients had scores of physiological function(78.25±2.53)points,physiological function(78.59±3.03)points,vitality(78.11±6.25)points,emotional function(77.59±5.29)points,social function(78.13±6.03)points,and mental health(79.02±7.01)points were higher than the control group(58.29±3.03)points,(57.12±3.05)points,(57.89±4.05)points,(60.12±5.05)points,(62.29±6.03)points and(62.29±6.03)points,the difference was statistically significant(t=36.463,36.011,19.578,17.225,13.394,13.047,P<0.05);the incidence of incision infection,urinary tract infection,hydronephrosis,renal damage and intestinal obstruction in patients undergoing laparoscopic radical bladder cancer surgery in the intervention group had no significant difference between the control group(P>0.05);before the intervention,the Arizona Sexual Experience Scale(ASEX)score(29.85±1.55)points and the International Erectile Function Index(IIEF-5)score(11.46±5.12)points of the intervention group of patients undergoing laparoscopic radical bladder cancer surgery were the same as those of the control group(29.92±1.53)points and(11.66±4.85)points,the difference was not statistically significant(t=0.231,0.204,P>0.05);after the intervention,the ASEX score(14.63±2.73)points of the intervention group was lower than that of the control group(22.46±4.36)points,the difference was statistically significant(t=10.976,P<0.05).The IIEF-5 score(17.49±3.32)points was higher than the control group(13.62±2.55)points.The difference was statistically significant(t=6.666,P<0.05).Conclusion The application of orthotopic ileal neobladder surgery shows high operational difficulty,but it can preserve the normal urination function of patients undergoing laparoscopic radical bladder cancer surgery,and will not have a serious impact on their postoperative sexual function and quality of life,and finally achieve effective prognosis of patients undergoing laparoscopic radical bladder cancer surgery.